EATING DISORDERS

Fashion Models

August 2006:

22 year old

Luisel Ramos-

Uruguay

Died: heart

failure after

fashion show

Result of: Anorexia Nervosa

“self-imposed starvation”

Her diet: lettuce leaves + diet coke

5’ 9”

Weight 98 pounds

BMI 14.5

October 2006

21 year old

Ana Carolina Reston

Brazilian model

Died:

Anorexia

Nervosa

February 2007

Eliana Ramos

18 year old

sister of Luisel

Model:

died of

heart attack

Related to:

“malnutrition”

Body image: way you perceive of your body

Continuum

Food Eating

is not Disordered

an issue

Body Body Hate/

Ownership Dissociation

Body Image:

Your

perception

Eating Disorders

• Psychiatric disorder

• Severe disturbances: body image & eating behavior

• Impairs: psychosocial health & physical health

• 2 common types: 1) anorexia nervosa & 2) bulimia nervosa

Anorexia Nervosa

• Self- starvation

• Severe

nutrient

deficiencies

• May

result

in death

Bulimia Nervosa

• Extreme overeating

• Followed by

compensation

to prevent

weight gain:

Self-induced vomiting, misuse of laxatives, fasting, excessive exercise

What causes eating disorders?

Many possible factors: interactions

• Psychological

• Interpersonal

• Social

• Genetic/biological

Family Environment & Eating Disorders

Family Environment

In general:

• Family “conditioning” influences eating behavior

• Childhood eating influenced by parents/guardians

• Eating together as a family vs. eating alone: making your own meals

• Choice/type of foods


• One child with eating disorder:

chances- sibling eating disorder

• Child with anorexia-

family may be:

A) More rigid- structured

B) Less open to discussion- disagreeable topics


Child with bulimia

Family:

A) Less stable structure

B) Less nurturing

C) More angry interactions

Physical/Sexual abuse: risk of eating disorders

Sociocultural Factors

• American/European cultures- emphasis on slenderness & self-discipline

• Associated with health, wealth, beauty

• Eating disorders- more common- white females in these cultures

• Other developing countries: excess body fat = desirable

Sociocultural Factors

• Comments by family, friends, teachers affect way we look at ourselves

• Peer teasing/pressure

about weight

Body dissatisfaction

Eating disorders

Christy Henrich

• Gymnast- failed to

Make 1988 Olympic

Team

• 4’11’’ 98 pounds

• US judge says she

was “too fat”

• Dieting/obsessive exercise

• New weight 47 pounds

• Died- anorexia 1994

Unrealistic “Media” Body Image

• Media ads “computer enhanced”

• Lean, beautiful women

• Eating disorders: white women

• Adult men & women- understand images- unrealistic


• Adolescents:

developing

identity/

body image

• Unfavorable

comparison: their body

with “perfect” female body

• Body image influence eating behavior

Body Image:

changes

over

the years

Personality Traits

Anorexia- Relationships

• Obsessive-compulsive disorder (compulsion- repeat certain behavior)

• May be inherited

• Families: one child

with anorexia:

• Another child with OCD

• Perfectionism

• Socially inhibited

• Emotional restraint

Personality Traits

Bulimia- Relationships

• Impulsive behavior

• Low self-esteem

• Erratic personality

• Self-criticism, negative moods overeating

• Substance abuse

• Anxiety disorders

Personality Traits

Eating disorders: person uses “food” to gain control over his/her life and increase self- esteem

Genetic & Biological Factors

Anorexia & Bulimia

• More common among biological relatives with these disorders

• Twin studies: bulimia

50% genetic 50% environment

influences

Genetic & Biological Factors

• Twin studies: anorexia

• 50-75% chance one twin 2d twin

• Even if raised: different families

• Multiple genes: may influence eating disorders

• Other biological factors: imbalances- chemicals regulating: hunger/appetite/digestion

Anorexia Nervosa

American Psychiatric Association

• Affects 0.5-1% US females

• Anorexia: 90-95% young girls/women

• Most common psychiatric disorder in women

• Leading cause deaths females: 15-24 years old

• Lower prevalence- males

Anorexia Nervosa: characteristics

• Restricted eating (few calories/day): “self-starvation”

• Fear of weight gain/becoming fat

• Anxiety, stress: 1-2 pound gain

• “Disturbed perception”: own body weight/shape

Anorexia Nervosa: Behavioral signs

• Person avoids eating situations

• Weighs self often

• Monitors food

intake rigidly

• Unhappy: body size

• Denial- being hungry

Physical Signs

• Body weight (< 85% normal)

• Energy, fatigue

• Unsteady walk

• Complaints: being cold

• Growth of fine/soft hair on face/arms: body’s attempt- temperature regulation

• Thin hair/hair loss

• Excessive exercise

Anorexia: Health Risks


• Body uses fat & lean tissue for energy maintain vital functions

• Shut down non-vital functions (conserve energy)

• In children/adolescents: growth slows/stops


1) Skin, hair, nails: dry, fragile, thin, brittle

2) Blood/immune system: anemia, risk infections

3) Kidneys: dehydration, electrolyte imbalances: arrhythmias death

4) Renal failure

5) Reproductive system

Reproductive hormones

Amenorrhea (no menstrual periods)

Infertility

6) Muscles: muscle tissue (catabolized for energy)

7) Brain: changes in neurotransmitters, mood

8) Heart: abnormal heart rate, blood pressure dizziness/fainting, arrhythmias

9) GI system: pain, bloating, constipation, irritable bowel syndrome

10) Bones: Bone density

“Dying to be Thin” Globe 3/31/08

• Higher rates eating disorders: Type 1 diabetics

• 1/3 women with Type 1 diabetes may skip/skimp on insulin to lose weight

• Kidney, eye, nerve, foot damage

• Insulin blood glucose, urine glucose (loss calories), weight

Jacqueline Jean Walsh

• Felt uncomfortable

with weight gain:

86 98 pounds

• Insulin under dosing:

started- high school

Westford

• Began wasting away

• Loss clumps of hair

• Died 2004: age 27

• Mom found diaries

Bulimia: binging & purging

• Affects: 1-4% of women

• Predominantly women

• Sometimes- men in sports that encourage low body weight:

horse racing, wrestling, crew, gymnastics

• ½ people-

anorexia: also

diagnosed with bulimia

Bulimia: symptoms • Low-self esteem/depression • Withdrawal: family & friends • Overly concerned: body shape and

weight • Binging: 2X or more/week • Large amount- food/short time: 12 brownies

+ 2 quarts ice cream: 30 minutes

Bulimia: symptoms

• Guilt feelings purging

• Vomiting

• Laxatives

• Diuretics

• Enemas


• 1-2 days of fasting (no food)

Binge- Purge Cycle

Bulimia: Physical Signs

• Disappearance from house: large amounts of food

• Frequent trips:

bathroom


• Swelling cheeks,

swelling salivary glands

• Complaints: GI discomfort/pain

Bulimia: Health Risks

• Electrolyte imbalances: due to sodium + potassium + water loss: vomiting

• Irregular heart rate: heart failure/death

• GI tract: Inflammation/ulceration- rupture of esophagus/stomach, irregular bowel movements, constipation

Bulimia: Health Risks

• Tooth decay/staining/gum disease due to stomach acids- vomiting

• Calluses: back of hands/knuckles: self-induced vomiting

• Broken eye blood vessels- pressure from vomiting

Body Image Males

“Reverse Anorexia Nervosa”

? New Male Eating Disorder

• Seen in males- often overweight

• Distressed if not lean/muscular

• “Concern”: body fat or ”getting fat again”

• More emphasis (vs. women) on % muscle mass instead of total body weight

• Misperception of being “small & frail”

• Body image distortion: strive for “idealized” body size/shape

Warning Signs

• Rigid/excessive weight training schedule

• Strict adherence: high protein, muscle-enhancing diet

• Use of anabolic steroids, protein powders, muscle-enhancing supplements

• Avoidance: social situations- where not able to follow strict diet

• Frequent: critical self-evaluation of body composition

• Weight control: more often- excessive exercise (vs. female methods: calorie restriction, vomiting, laxatives)

Dietary supplements to lose weight

2003: Baltimore

Oriole Pitcher

Steve Bechler

Died from using

dietary supplement

containing ephedra

Ephedra (ephedrine):

Stimulant isolated from plants

or made synthetically

• Rapid heart rate, blood

pressure increase, dizziness,

sweating, headache, sleep problems

• Linked to: heart attack/stroke/death

• 2004 FDA banned dietary supplements containing ephedra

Gaining weight in underweight person

• Underweight BMI <18.5

• Gaining weight often as

difficult as overweight

person losing weight

• Possible causes: genetics,

lifestyle, chronic diseases,

psychological disturbances

• Evaluation by doctor-

find underlying cause(s)

To gain weight

• Gradual increase in calorie-

dense foods

• Healthy fats

• Fatty fish, salmon, olives,

avocados, seeds, low fat cheeses,

nuts, peanut butter, bananas, granola

• Fruit juices, low fat smoothies, milk shakes vs. soft drinks

• Regular meals + snacks

• Weight lifting + calorie intake

2 other Eating Disorders

•Binge Eating Disorder

•Night Eating Disorder

Binge Eating Disorder: compulsive overeating

Stressful event “go on an

(work, eating binge”

relationships,

school)

• Eat large amounts food/short period

• > 2X/week

Binge Eating Disorder

• Common in men, minority groups

• People often: overweight

• Amount of food without purging

• Weight gain

Binge Eating Disorder: Symptoms • Rapid eating • Eating until uncomfortably full • Eating when not hungry • Eating alone/in secret • Feelings: disgust, depression, guilt • Negative self-esteem • Substance abuse • Anxiety disorders

Health Risks

• Risk: overweight/obesity

• Increased risk: heart disease/stroke,

blood pressure, arthritis

• Binge foods eaten: high in fat & sugar: blood lipids

• Stress from binge eating: low self-esteem, depression, negative thoughts

Night Eating Syndrome

Night Eating Syndrome • First reported 1955- Dr. Albert

Stunkard • Patients: not hungry in morning • Eat little during day • Insomnia/altered sleep patterns • Spend evening/night: eating • 8 PM- 6 AM: most energy consumed

vs. day • Eat high calorie snacks- middle of

night

Night Eating Syndrome • No binging • Risk obesity • Occurs in people: obese, weight-loss

clinics, weight-loss surgery • May be stress related • Changes: brain neurotransmitters,

hormones • Depression/mood disorders • Risk: heart disease, stroke, blood

pressure, diabetes, arthritis, sleep apnea

Weight Cycling: Yo-Yo Dieting

Weight Cycling: Yo-Yo Dieting

• Also called: “Chronic Dieting”

• Successful weight loss then….

• Regain of lost weight

• Repeat of cycle: over/over again

• Stress related to dieting: cortisol

(Stress hormone-adrenal gland)

Symptoms • Preoccupation:

food/calories/weight/body size/shape

• Strict dieting

• Person classifies food:

“good” or “bad”


• Chronic fatigue

• Mood swings

• Loss concentration

Health Risks

• Poor nutrient/energy intake

• Loss- lean tissue

• Poor bone health

• Fatigue

decreased ability to exercise

• May develop: anorexia or bulimia

Underlying Problem:

• Severe restriction- calories

• Metabolism slows

• BMR faster than weight loss

• Result: need even greater reduction in calories to lose weight

• Frustration

Better approach to weight loss

• Exercise/activity (aerobic/weights): +300-500 burn additional calories/day

• Moderate in food/drink:

- 300-500

calories/day

Achieve: energy (calorie) deficit

Better approach to weight loss

• Nutrient dense/low calorie foods

(volumetrics)

• Result: Fat tissue

• Minimal changes: lean tissue & BMR

Female Athlete Triad


• Syndrome: seen in female athletes

• 3 components:

A) Disordered eating

B) Menstrual dysfunction (amenorrhea)

C) Osteoporosis

Females at risk: sports emphasizing leanness

• Dance • Figure skating • Diving • Gymnastics • Long distance running • Cycling • Cross-country skiing • Horse racing • Rowing • Martial arts • Sports requiring: weigh-ins, weight specific

categories

Pressure to be thin/have certain body size

General: Coaches, Teammates,

Social, Judges, Spectators

Cultural

Fear: cut from team, loss athletic scholarship, elimination during competition

Result: some female athletes

Disordered Eating

• Energy (calorie) deficit

• Sex hormones

• Disrupts menstrual cycle: amenorrhea

• Estrogen (needed for bone density)

• Risk: osteoporosis

• Risk: muscle/bone injuries; stress fracture


Treatment: multidisciplinary approach

Work together:

• Coach, trainer, nutritionist, exercise physiologist, psychologist, parents, friends

Eating Disorders: Treatment

Multidisciplinary Team Approach

American Psychiatric Association

5 levels depending on:

1. Severity

2. Type of Disorder

Eating Disorders: Treatment

Level 5 Inpatient hospitalization

Level 4 Residential Treatment Center

Level 3 Partial Hospitalization

Level 2 Intensive Outpatient

Level 1 Outpatient

Eating Disorders Treatment

• Physical exam, diagnosis, identification-underlying causes

• Team members: meet with patient and family & friends (ask questions about severity- patient may be in denial)

• Severity level: A) severe malnutrition: hospitalization, stabilize condition, refeeding; B) underweight but medically stable: outpatient

Eating Disorders Treatment

• Key: education (patient & family), advice, support

• Encourage healthful eating

• Minimize distress about food, body weight/shape

• Nutritional counseling (dietician)

• Psychotherapy: psychiatrist, psychologist

• Family Therapy, Support groups

• Medications (antidepressants)

• After weight gain: Continue treatment 1-2 years- prevent relapse, medications

Eating Disorders: key- recognizing risk factors prevention

Emphasis:

• Achieve healthy weight for person: maintained for life

• Weight based on: genetics, environment, exercise opportunities

vs.

• Striving for unhealthy body weight, constant dieting, disordered eating behaviors

Prevention

• Peer/family

weight related

teasing/criticism

• Help children understand

“unrealistic” media body images

• Encourage physical activity/sports in children: prevent weight gain

• Establish good eating behaviors: school, home, outside (friends)

Prevention

• Teach children about nutrition: foods to encourage vs. limit

• Encourage children to walk: to/from school, at school, work, home

• Have parents be role models: healthy diet/exercise

• Emphasize positive comments: children’s body image, appearance during their development

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